BACKGROUND No guidelines are available for defining the extent of lymph node (LN) dissection in patients with remnant gastric carcinoma (RGC). Hence, this retrospective study aimed to determine the optimal extent of LN dissection in patients with RGC. METHODS We retrospectively evaluated the therapeutic outcomes of node dissection for RGC from a nationwide registry. When the metastatic rate or 5-year survival rate exceeded 10%, dissection was recommended. We calculated the dissection index by multiplying the incidence of metastasis at that nodal station by the 5-year survival rate of patients with metastasis at the station. A dissection index of > 1.0 was considered significant. RESULTS We included 1133 patients with RGC (T2-T4 tumor) who had undergone distal gastrectomy as the primary surgery for the evaluation of the survival benefit of nodal dissection. Any regional node station was considered significant. When the primary surgery was for malignant disease, the index was high for Nos. 3 (10.2), 7 (9.5), 1 (7.1), and 9 (8.0) nodes. For nodes at the splenic hilum, the index value was 4.4, which was higher than that for the perigastric nodes (Nos. 4sa and 4sb). The index for No. 10 nodes was the highest (10.5) when tumors involved a greater curvature. CONCLUSIONS The therapeutic strategy for RGC remains the same, regardless of the histology of the primary disease during the initial surgery. Total gastrectomy and dissection of the perigastric LNs (Nos. 1-4), suprapancreatic LNs (Nos. 7-9 and 11), and LNs at the splenic hilum (No. 10) are justified.

中文翻译：

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远端胃切除术后残余晚期胃癌淋巴结清扫的最佳范围：对来自日本胃癌协会全国登记处的 3000 多名患者的回顾性分析。

背景 尚无指南可用于定义残胃癌 (RGC) 患者的淋巴结 (LN) 清扫范围。因此，这项回顾性研究旨在确定 RGC 患者淋巴结清扫的最佳范围。方法 我们回顾性评估了来自全国登记处的 RGC 淋巴结清扫术的治疗效果。当转移率或5年生存率超过10%时，建议切除。我们通过将该淋巴结转移的发生率乘以该淋巴结转移患者的 5 年生存率来计算解剖指数。> 1.0 的解剖指数被认为是显着的。结果 我们纳入了 1133 名接受远端胃切除术作为主要手术的 RGC（T2-T4 肿瘤）患者，以评估淋巴结清扫的生存获益。任何区域节点站都被认为是重要的。当初次手术是针对恶性疾病时，3 号（10.2）、7 号（9.5）、1 号（7.1）和 9 号（8.0）淋巴结的指数较高。对于脾门处的淋巴结，指数值为 4.4，高于胃周淋巴结（4sa 和 4sb）。当肿瘤涉及较大曲率时，10 号淋巴结的指数最高 (10.5)。结论 无论初始手术期间原发疾病的组织学类型如何，RGC 的治疗策略都保持不变。全胃切除术和胃周淋巴结（1-4 号）、胰腺上淋巴结（7-9 号和 11 号）的解剖，